Impact of Periprocedural Bleeding on Incidence of Contrast- Induced Acute Kidney Injury in Patients Treated with Percutaneous Coronary Intervention.
ABSTRACT OBJECTIVES: We sought to evaluate the association between contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI) and severity of bleeding estimated from periprocedural hemoglobin (Hb) measurement. BACKGROUND: The relationship between CI-AKI and bleeding in contemporary practice remains controversial. METHODS: In a retrospective analysis of the prospectively maintained JCD-KICS multicenter registry, we divided 2646 consecutive patients into 5 groups according to the change of Hb level post relative to pre PCI: patients without Hb level decrease (Group A); and patients with decreased Hb level: <1g/dL (Group B); 1-<2g/dL (Group C); 2-<3g/dL (Group D); and >3g/dL (Group E). CI-AKI was defined as an increase in serum creatinine (Cr) level ≥0.5 mg/dL or ≥25% above baseline values at 48 hours after administration of contrast media. Procedural and outcome variables were compared. RESULTS: Mean age was 67±11 years. Of 2646 patients, 315 (11.9%) developed CI-AKI. CI-AKI incidence was 6.2%, 7.5%, 10.7%, 17.0%, and 26.2%, in groups A through E, respectively (P < 0.01), whereas incidence of major bleeding was 0.7%, 1.3%, 2.0%, 4.1%, and 28.3%, respectively (P < 0.01). CI-AKI was associated with higher rates of mortality (5.4% vs. 0.6%, P < 0.01), and also of the composite of heart failure, cardiogenic shock, and death (16.5% vs. 2.8%, P < 0.01). CONCLUSIONS: Periprocedural bleeding was significantly associated with CI-AKI, with CI-AKI incidence correlating with bleeding severity.
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ABSTRACT: A knowledge of the distribution of different fluids given by intravenous infusion is basic to the understanding of the effects of fluid therapy. Therefore, a mathematical model was tested to analyze the volume kinetics of three types of fluids. The authors infused 25 ml/kg of Ringer acetate solution, 5 ml/kg of 6% dextran 70 in 0.9% NaCl, and 3 ml/kg of 7.5% NaCl over 30 min in 8 male volunteers aged from 25 to 36 years (mean, 31 years) and measured the changes in total hemoglobin, serum albumin, and total blood water over time. The changes were expressed as fractioned dilution and then plotted against time. The curves were fitted to a one-volume and a two-volume model, which allowed an estimation of the size of the body fluid space expanded by the fluid (V) and the elimination rate constant (k(r) to be made. The changes in blood water concentration indicated a mean size of V of 5.9 1 (+/- 0.8, SEM) for Ringer's solution, 2.6 (+/- 0.3) 1 for dextran, and 1.2 (+/- 0.1) 1 for hypertonic saline. The corresponding values of k(r) were 94 (+/- 42), 12 (+/- 6), and 30 (+/- 4) ml/min, respectively. Blood hemoglobin indicated a degree of dilution similar to that indicated by blood water. Serum albumin indicated a more pronounced dilution, which resulted in a larger expandable volume and a greater mean square error for the curvefitting. The larger volume obtained for serum albumin can probably be explained by a loss of intravascular albumin into the tissues along with the infused fluid. The distribution of intravenous fluids can be analyzed by a kinetic model adapted for fluid spaces, but slightly different results are obtained, depending on the marker used to indicate dilution of the primary fluid space. Analysis and simulation of plasma volume expansion by this model is a tool that can help the anesthetist to better plan fluid therapy.Anesthesiology 09/1997; 87(2):204-12. · 5.16 Impact Factor
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ABSTRACT: Serum creatinine concentration is widely used as an index of renal function, but this concentration is affected by factors other than glomerular filtration rate (GFR). To develop an equation to predict GFR from serum creatinine concentration and other factors. Cross-sectional study of GFR, creatinine clearance, serum creatinine concentration, and demographic and clinical characteristics in patients with chronic renal disease. 1628 patients enrolled in the baseline period of the Modification of Diet in Renal Disease (MDRD) Study, of whom 1070 were randomly selected as the training sample; the remaining 558 patients constituted the validation sample. The prediction equation was developed by stepwise regression applied to the training sample. The equation was then tested and compared with other prediction equations in the validation sample. To simplify prediction of GFR, the equation included only demographic and serum variables. Independent factors associated with a lower GFR included a higher serum creatinine concentration, older age, female sex, nonblack ethnicity, higher serum urea nitrogen levels, and lower serum albumin levels (P < 0.001 for all factors). The multiple regression model explained 90.3% of the variance in the logarithm of GFR in the validation sample. Measured creatinine clearance overestimated GFR by 19%, and creatinine clearance predicted by the Cockcroft-Gault formula overestimated GFR by 16%. After adjustment for this overestimation, the percentage of variance of the logarithm of GFR predicted by measured creatinine clearance or the Cockcroft-Gault formula was 86.6% and 84.2%, respectively. The equation developed from the MDRD Study provided a more accurate estimate of GFR in our study group than measured creatinine clearance or other commonly used equations.Annals of internal medicine 04/1999; 130(6):461-70. · 13.98 Impact Factor
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ABSTRACT: In patients undergoing percutaneous coronary intervention (PCI) in the modern era, the incidence and prognostic implications of acute renal failure (ARF) are unknown. With a retrospective analysis of the Mayo Clinic PCI registry, we determined the incidence of, risk factors for, and prognostic implications of ARF (defined as an increase in serum creatinine [Cr] >0.5 mg/dL from baseline) after PCI. Of 7586 patients, 254 (3.3%) experienced ARF. Among patients with baseline Cr <2.0, the risk of ARF was higher among diabetic than nondiabetic patients, whereas among those with a baseline Cr >2.0, all had a significant risk of ARF. In multivariate analysis, ARF was associated with baseline serum Cr, acute myocardial infarction, shock, and volume of contrast medium administered. Twenty-two percent of patients with ARF died during the index hospitalization compared with only 1.4% of patients without ARF (P<0.0001). After adjustment, ARF remained strongly associated with death. Among hospital survivors with ARF, 1- and 5-year estimated mortality rates were 12.1% and 44.6%, respectively, much greater than the 3.7% and 14.5% mortality rates in patients without ARF (P<0.0001). The overall incidence of ARF after PCI is low. Diabetic patients with baseline Cr values <2.0 mg/dL are at higher risk than nondiabetic patients, whereas all patients with a serum Cr >2.0 are at high risk for ARF. ARF was highly correlated with death during the index hospitalization and after dismissal.Circulation 05/2002; 105(19):2259-64. · 15.20 Impact Factor